HomeMy WebLinkAboutMortgage_Robb (5) *. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
y FOR DEDUCTION FROM ASSESSED VALUATION //�� •
10S State Form 43709(R14/1-20) V �SD Y) �OYl OW1?.(� ��
i� Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: To be filed in person or by mail. Form filed with:
Filing Date: Form must be completed and dated in the calendar year for which the deduction is sought. Q.-""County Auditor
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is County Recorder
located on or before January 5 of the calendar year in which the property taxes are first due
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Applicant(o neer or contract buyer--see restrictions on reverse siide),
'In t11, 1 0 bin / '5 bh W c-Z g V � Record number Page er
Taxing District Key number/legal description a\ �2� `
Moth+So tvtie✓� al:-II-31- 36 c�o- otJ• �Sg_ 0 J ,
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is theor appli ant the ee sole
assessment date,current year assessment date,current year date of applicationlegal
3 1 eXite Yes ❑No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
Is the property in question:Annually Assessed
If name on record is different than that of applicant,indicate below: teal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller FILED
'S/3 3 1-0•v. --
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage U L L 1 6 2022
Address of assignee(number and street,city,state,and ZIP code) h_
C'(Ps'SONt lia4r4 Yer LM tiTORyes,state amount of deduction
Does applicantoun own property in any If yes,what county? What Taxing District? on property for �N
in Inr county r—r.es ❑No current year? es ❑No
in Indiana? LT��
A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's office(including any home equity line of credit that is recorded in the county recorder's office)that is the basis for the deduction.
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor ue County/ Date(month,day,year)
under
V'vr
I,We certify und the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/ t buyer of the aforem tioned property on date application is filed.
Date(month,day,year)
Sig re(own s full name) / IzOZz J�j7 // 2
Full r nt address of applicant( mber and street,city,state,and ZIP code) \1 T
34 O W Ave. I 51-4.1 lee;w" t,Jevtsv t 1�
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.
;EC::T FOR FILING STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
Name of mortgagee or contract seller
Name of applicant r
�ahrwrt �ob b h W il't j �� Tt;/3 /3c`�(—
IAmount of indebtednessTaxing District
Date filed(month,day,year) Md�t„gG�YNe.�i�
l (ta/ad �3/, Boa JKey num er/legal description
.4-l1- 31 - 3c - GU`{ - ASS?- c� -Signature of County Auditor I County RecorderCou Date(month,day,year)
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